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Medical Staff Committee Assignment Requests

Submit Your Request by May 2

Medical staff members who are in the Active Attending category and interested in serving on a Medical Staff Committee are asked to complete a Committee Assignment Request form. Please indicate which committee(s) you would like to serve on for the July 2008 - July 2010 term.

Requests must be submitted no later than Friday, May 2.

On the questionnaire, please indicate which committees you currently serve on, then under 2008-2010 Committee Preferences, please rank your first two committee choices for service beginning July 2008.

Please note: if you are currently serving on a committee and would like to continue, you must submit a request form. Continued service is contingent upon having met the attendance requirement during your past term.

A CSMC Exchange e-mail address is required for those who serve on a Medical Staff Committee, and this information must be provided on the questionnaire. All meeting notices, agendas, minutes and other correspondence will be conducted by CSMC Exchange e-mail only due to confidentiality. Please call (310) 423-2828 to confirm or update your CSMC Exchange account information.

All physicians assigned to Medical Staff committees are required to complete an annual Conflict of Interest disclosure questionnaire. The conflict of interest policy can be viewed on the Cedars-Sinai Intranet home page. You will receive an e-mail from ConflictOfInterest@cshs.org with your username, initial password and sign-on instructions. You will have 30 days to complete this questionnaire.

Failure to complete the questionnaire will result in dismissal from your assigned committee(s). If you have already completed your COI questionnaire for 2008, you will not receive an e-mail; however, if you have any updates since completing the questionnaire, please log in and update your record accordingly.

Should you be assigned to a committee, it is required that you attend, at minimum, 50 percent of the meetings during the first year of your term or you will not be eligible to continue into the second year.

Please send your completed Committee Assignment request form to gina.rose@cshs.org or fax it to (310) 423-0448. You can also mail it to: Cedars-Sinai Medical Center, Chief of Staff Office, 8700 Beverly Blvd., Suite 2211, Los Angeles, CA 90048.